To Floss or Not to Floss

When I got up this morning, I flossed my teeth just as I do every morning. I have been doing that for as long as I can remember because my dentist said I should. Also because I believed there had been studies that showed flossing can help prevent periodontal disease, which can reduce risk for heart disease and even dementia.

But, a new catch has come along… it turns out that maybe the research about the benefits of flossing is not so solid. In early August the Associated Press (AP) reported that the research that has been cited for years is less than stellar and really does not prove the benefits of flossing.

According the story on the AP’s Big Story website, the federal government started recommending flossing in 1979 in The Dietary Guidelines for Americans which are issued every five years. By law the guidelines must be based on scientific evidence. Last year the AP requested the evidence under the Freedom of Information Act.

This year’s dietary guidelines do not include the recommendation for flossing. In a letter to the AP the government acknowledged that the evidence to support flossing was weak as a number of scientific reviews of available evidence have confirmed.

Researchers say that due to the nature of flossing, it is impossible to do a double blind placebo controlled study-the gold standard for scientific evidence. And doing the most rigorous type of research is very costly.

While there is some evidence that flossing reduces bacteria and plaque in the mouth, the studies have not convincingly linked flossing to the prevention of periodontal disease. And periodontal disease is what we are trying to avoid as it causes bone loss leading to loss of teeth and is connected to other health issues like heart disease.

In the meantime the American Dental Association is not changing its recommendation on flossing and said in a press release that, “A lack of strong evidence does not equate to a lack of effectiveness… flossing is an important oral hygiene practice.” They went on to list important health organizations that are still recommending flossing like the Center for Disease Control, the National Institutes on Health and Healthy People 2020.

So, where does this leave us? The truth is that only about 12% of people actually floss on a daily basis. So I am guessing that those folks who currently floss will continue (I know I will) and those who don’t won’t.

The lesson is that medicine is not an exact science, and sometimes recommendations get passed along based on some measure of truth, but not firmly rooted in solid evidence. We should be careful to follow our health care practitioner’s recommendations while keeping an open mind to new findings.